Stress responses, social support and death care experience among spouse caregivers of young and middle-aged patients with terminal cancer: a mixed-methods analysis.

Background: Faced with cancer patients in the near-death stage, spousal caregivers may experience a series of stress reactions and have a high risk of suffering from physical and psychological problems. Good social support can help alleviate stressful reactions. Objectives: To investigate stress responses and social support among spouse caregivers of young and middle-aged patients with terminal cancer in the near-death stage, and to explore the death care experience of spouse caregivers. Methods: A prospective mixed-methods study was conducted. Questionnaires of stress response questionnaire and social support rating scale were used to investigate stress responses and social support of spouse caregivers. And semi-structured interviews were conducted to explore the death care experience of spouse caregivers in at a university-affiliated hospital in China. Results: Spouse caregivers with higher social support scores were significantly more likely to have poor stress response. Meanwhile, whether the spouses had alternative care for other dependents, the number of venous pathways and instruments in/on the patient's body significantly affected the spousal stress response. Among them, spousal social support was the best influencing factor to predict spousal stress response. Four qualitative themes of the death care experience were identified. Theme 1: Psychological feelings of spouses caregivers when they care for the patients' physical function. Theme 2: Psychological feelings of spouse caregivers when they communicated with the patients. Theme 3: Psychological feelings of spouses caregivers when they will being widowed soon. Theme 4: The focus of life shift, and life concept change. Conclusion: Overall, spousal stress response was statistically affected by alternative caregivers for spouses, spousal social support, and the number of venous pathways and instruments in/on the patient's body. Among that, social support was the best influencing factor to predict the stress response. Meanwhile, spousal caregivers was distressed and felt deeply fear, wronged and helpless deep and when facing the patients' dying symptoms and communicating with patient, and reflected on the essence of life, and changing the concept of life. Implications for practice: Medical staff should pay special attention to spousal caregivers' physical discomfort and improve spousal social support, and provide targeted information and assistance to decrease spousal stress response in the near-death stage of cancer patients.